胃底静脉曲张出血33例临床分析

Clinical analysis of thirty three patients with bleeding gastric varices

目的分析胃底静脉曲张出血的病因、诊断和治疗方法.方法回顾分析该院1994年元月～2003年12月检查确诊为胃底静脉曲张出血33例,对其临床资料进行分析讨论.结果病因:肝硬化门脉高压23例,肝癌6例,脾静脉阻塞4例.治疗结果:内镜下套扎17例;5例于1～3 d内复发大出血死亡,另有9例2个月内复发出血,硬化剂治疗4例,均有复发出血;17例行手术治疗,14例术后无再出血,3例虽有复发出血,但频率及出血量明显减少.结论胃底静脉曲张是门脉高压,特别是脾胃区门脉高压的表现.胃底静脉曲张较食管静脉曲张出血率低,但出血更严重.内镜对胃底静脉曲张的诊断价值有限.对胃底静脉曲张不宜行套扎或硬化剂治疗.能手术者应首选手术治疗,不宜手术者可考虑介入治疗,栓塞胃底静脉.

To analyze the etiology,diagnosis and treatment of bleeding gastric varices. 33 ptients were diagnosed as bleeding gastric varices in our hospital during January 1994 to December 2003, and the clinical data were analyzed. Etiology: cirrhosis and portal hypertension (n=23), hepatic cancer (n=6), spleen vein emphraxis (n=4). Therapy: 17patients were treated with endoscopic ligation, 5 patients of which were died in 1 to 3 days due to rebleeding and 9 patients of which rehemorrhage in 2 months after treatment. 4 patients were treated with sclerotherapy and rehemorrhaged. Surgery peformed in 17cases, 14 of which did not rehemorrhage after operation. Although 3 cases by operation rehemorrhaged, both the frequency and bleeding volume decreased significantly. [Conclusions] Gastric varices should be considered to be the clinical character in patients with portal hypertension,especially in region of spleen and stomach. The bleeding frequency in gastric varicees was lowerer than in esophageal varices, but more severely. Endoscopic value in diagnosis for Gastric varices was restricted. The operation was choosed firstly in patients with gastric varices which endoscopic ligation and sclerotherapy were not be applied,otherwise, gastric varical occlusion were considered.